Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
NORTHERN WAYNE HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
412 COMO ROAD, LAKE COMO, PA 18437-0000
(570) 798-2828
(570) 798-2636
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 253-8226
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS011217
PA
207R00000X
Internal Medicine Physician
MD428487
PA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007765560005
—
PA
Enumeration date
12/03/2007
Last updated
04/07/2015
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